Health and Social Care

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Dr. Brand: I beg to move, That the clause be read a Second time.

The Bill is wide-ranging, and we were disappointed that the Government did not include provisions on patients' rights to information, which many of us felt were necessary. I am grateful to my hon. Friend the Member for Sutton and Cheam, who has done a lot of work with the citizens advice bureau in drafting the new clause.

I have never struck a patient off my list, but I have occasionally been relieved when patients have gone. The relationship between doctors and patients works better when they get on with each other, or at least are not at open war. It is important for practitioners to analyse why they take people off their list or why they refuse to accept them. It is also important for the reasons why a relationship has broken down to be explained to a patient.

It would be helpful to the contractor and the patient if the Minister considered the substance behind new clause 15. Many people in patient and consumer organisations and in the NHS have felt that the problem is long overdue for attention.

Mr. Swayne: We are generally supportive of the provisions in the new clause. Constituents have come to see me at my advice sessions to complain that they have been removed from their GP's list. I must say that I had some understanding of the GP who removed them. I have often felt that if there were a power for a Member of Parliament to remove a constituent from his list, it might well be worthwhile pursuing such a power.

Dr. Brand: There is always the option to invite them to vote for another candidate, which is something I quite frequently do.

Mr. Swayne: The hon. Gentleman is very kind. However, it is quite proper to remove patients from a GP's list and there are provisions for their immediate removal in cases of violence. That is quite right. Nevertheless, there is a clear case to be made for written reasons to be made available to the patient. That would prevent many abuses. The medical professional bodies regard it as best practice to provide the reason. Therefore, I see no reason, for not requiring it to be provided. Perhaps we could turn the matter on its head and ask the Minister to come up with plausible reasons for saying why and in what circumstances it would not be proper to provide a written reason for removing someone from the list?

3.30 pm

Mr. Denham: We have an opportunity for a brief debate on a topic that we should not be trying to resolve through this Bill, although it is certainly a live one that has concerned this House and the Health Select Committee and I shall refer to the work that is under way. GPs have always had the right to remove patients from their lists without giving a reason—just as patients have had the right to withdraw from a doctor's list without giving reasons. Historically, the view has been that the need for either party to give a reason could be an inhibiting influence on what might be the appropriate course of action. We would expect GPs to exercise their option to de-register patients only where there has been an irretrievable breakdown of the doctor-patient relationship or where the patient has been violent, or has threatened violence towards the GP or the GP's staff. The General Medical Council has advised doctors that they should not end their professional relationship with a patient unless they are satisfied that the decision is fair and does not contravene general guidance that it is unacceptable to discriminate on grounds of lifestyle, culture, belief, race, colour, gender, sexuality, age, social status or perceived economic worth.

The Government are concerned that patients who are removed from GP lists without their consent are treated with consideration and openness. Being removed from a doctor's list can be a distressing experience and patients look for reassurance and explanation. It is worth noting that the profession's representatives advise doctors to give reasons for removal wherever possible.

The current position is that, following the recommendation of the Select Committee on Public Administration after the 1997-98 report of the Health Service Ombudsman, we have agreed to a survey into the scale of and the reasons behind patient removal by GPs. The survey was commissioned from the Medical Care Research Unit at Sheffield university and its report is expected before Easter.

Although I have not seen the results, I am advised that preliminary results give a national picture of de-registrations for reasons other than patients leaving the area, and seem to suggest that the main reason for removing patients is violence or threatening behaviour. However, it may be too early to be certain on the conclusions of that report.

We have commissioned the research and I would not like to pre-judge today what the Government's response might be when we have received this research and considered it properly. Certainly paragraph 10.5 of the NHS plan states that

``patient choice will be strengthened. Patients have the right to choose a GP.''

We want

``to make it easier for patients to exercise informed choice, [so] a much wider range of information will be published about each GP practice''.

Discussions are under way between the Department and the BMA to ensure that the GP practice leaflet includes additional information to enable patients to make informed choices. We want to see the results of the survey and then consider what further action may be needed to improve the handling of the difficult issue of separation of doctor and patient.

Dr. Brand: I am grateful for that reply. I hope that the Minister does not rely only on a survey and figures. It would be quite wrong if even a small number of patients were taken off GP's lists without reasonable cause: for example, so that their GPs could meet Government targets on immunisation. Families or extended families are sometimes thrown off a list because the GP does not get on with one family member. I hope that the Minister will also recognise that a code of good practice is an excellent mechanism for good practitioners, but it does not necessarily meet the requirements.

I beg to ask leave to withdraw the motion.

Motion and clause, by leave, withdrawn.

New Clause 16

Reviews of care trusts

`.—(1) The relevant authority shall, not less than two years and not more than three years after the date of designation of any trust as a Care Trust—

(a) arrange for a review of the operation and effectiveness of that trust; and

(b) arrange that the review includes consultation with all parties and bodies that the relevant authority considers have an interest in or are affected by the operation of that trust; and

(c) arrange that the review includes an evaluation of the benefits to recipients of health and social care services within the area of the trust.

(2) The relevant authority shall publish a report detailing the findings of any review conducted in accordance with subsection (1) above in such manner as it shall consider appropriate.'.—[Mr. Hammond.]

Brought up, and read the First time.

Mr. Hammond: I beg to move, That the clause be read a Second time. The new clause attempts to write on to the face of the Bill provision for proper review of the operation and effectiveness of care trusts when they are established and the publication of the results of those reviews. It would apply to care trusts established under clause 45 or clause 46 by which the Secretary of State takes powers to set them up by order.

We are prepared to be open-minded about care trusts. We have listened to the arguments for them and we understand the logic of what is being proposed. However, it is a complex matter and, as Ministers have acknowledged, care trusts depend for their success upon people being able to work together to deliver services. On Tuesday, the hon. Member for Isle of Wight (Dr. Brand) referred to the need to merge two different cultures—the local government social services approach and the health service ethos, which is somewhat different. Everyone would acknowledge that there is a fairly tough challenge ahead to make care trusts work.

We know that in some areas social services and health bodies work together extremely well and very closely, and in other areas, frankly, they do not. Given that experience, we all acknowledge that it is possible that the outcomes for care trusts will be different in different cases. There will be lessons to be learned and best practice to be picked up and spread around.

The Government are keen on talking about evidence-based medicine and health care, and that is the right way to proceed. However—the Minister will forgive me if I use the same example again—we are not encouraged by of what happened in respect of NHS Direct. It was a perfectly plausible idea—one that the previous Government piloted in Wiltshire—that may have much to contribute to the future delivery of health care services. We should also work always on the basis that as a scheme is rolled out and pilots are established, they are fully evaluated and costed and properly reviewed and that decisions are taken in the light not of the need for a press announcement or a headline grabber the next morning, but of the evidence available, subject to proper objective evaluation.

In new clause 16 we are telling the Minister that we believe that it is a practical necessity that the operation of care trusts is properly reviewed and that the results of those reviews are published, and that that is essential to building public and professional confidence in the bodies concerned.

I have no doubt whatever that it is the Government's intention to review what happens to the first wave of care trusts. It would be bizarre to imagine that the Government would not be very interested indeed in keeping a close eye on what is happening. However, we do not want to find that the model is being encouraged, or perhaps even a little more than encouraged—people may be under pressure to adopt it—on the ground of supposed benefits that the Government claim to have detected on the basis of some internal review the results of which are not available for scrutiny, and therefore for objective analysis.

I hope that the Minister will accept the new clause as an attempt to ensure that the roll-out of care trusts is based on proper evidence and that best practice is disseminated. If he cannot accept it, I hope that he will be able to give the Committee some clear assurances about the independence of the evaluations that will take place, and an assurance that those evaluations will be published so that other bodies that may be considering making the leap into care trusts will be able to learn from the experience of those who have already gone down that route and make a properly informed decision.

 

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Prepared 8 February 2001